Narcissist or Narcissistic? Comparing Models of Narcissistic Personality Disorder Symptoms

What is it about?

This study aimed to find a model of DSM-5 narcissistic personality disorder (NPD) symptoms which best described the disorder in different populations. We considered three main possibilities of classifying individuals: (a) as members of a category ("narcissists"), (b) according to their position on a narcissistic spectrum (individuals can be more or less "narcissistic" relative to each other), or (c) as members of categories which are defined by differences on the spectrum (a hybrid model). By comparing these models in an initial clinical dataset and finding that a dimensional model best captured NPD symptoms in 628 psychiatric patients, we formed the prediction that a narcissistic spectrum would also best describe symptoms in people generally. To support this prediction, we investigated whether the dimensional model would also have the best fit in four additional datasets with community, undergraduate, mixed community-clinical, and national samples in which symptom data were collected using different assessment approaches (e.g., self-report, clinical interview) and measures. The dimensional model outperformed categorical and hybrid models in our study, suggesting that narcissistic personality disorder symptomatology does not reflect a narcissist category but rather a continuum of narcissistic pathology. Much like we call people "tall" while recognizing that no one height measurement defines a "tall" category, people who fall on the high ends of the spectrum may be deemed "narcissistic" even though no single symptom cutoff can define a "narcissist."

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Why is it important?

Though NPD criteria are currently conceptualized in the DSM-5 as indicators of a narcissist category, a narcissistic spectrum is what best explains the variability in endorsement of the NPD criteria from an empirical standpoint. We see no apparent utility of imposing a strict symptom cutoff when analyses assuming the existence of categories yield no clear thresholds or compelling evidence of qualitatively distinct patterns. Imposing absolute thresholds has adverse clinical and research consequences, such as barriers to health care access and decreased statistical power. For instance, people who fall short of the arbitrary five symptom cutoff will not obtain a diagnosis to qualify them for insurance even if they experience significant difficulties from their four symptoms. As research participants, such individuals may be forced into a "healthy" category even though they more closely resemble individuals forced into the "narcissist" category. People can still be usefully distinguished for clinical and research purposes in a dimensional framework by investigating whether relatively high levels of factors contribute to impairment or associate with other variables of interest. Indeed, dimensions may serve as better measurement tools to study symptomatology across time (e.g., for evaluation of treatment progress) and to develop more fine-grained accounts of between-person differences.

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